A patient misdiagnosed with central serous chorioretinopathy: A case report

Abstract

Background: Due to some similarities in the manifestations between central serous chorioretinopathy (CSC) and polypoidal choroidal vasculopathy (PCV), PCV may be misdiagnosed as CSC. More attention should be paid to distinguishing these two disorders.

Case summary: A 52-year-old woman presented to our hospital with blurred vision in her left eye for approximately 1 wk. Anterior segment and intraocular pressure findings were normal in both eyes. Fundus photography of the left eye showed a seemingly normal adult oculus fundus without any obvious hard exudate or hemorrhage. Optical coherence tomography exhibited a hypo-reflective space beneath both the neurosensory retina and the pigment epithelium layer. The late phase of fluorescein angiography revealed increased leakage. The patient was initially diagnosed with CSC. At follow-up, however, the final diagnosis turned out to be PCV.

Conclusion: CSC and PCV are two different retinal entities. Lipid deposition and hemorrhage are the most important elements that lead to confusion between these two entities. Indocyanine green angiography should be performed to make a definitive diagnosis, especially in cases with suspected PCV.

Keywords: Case report; Central serous chorioretinopathy; Optical coherence tomography; Polypoidal choroidal vasculopathy.

Figure 1

First examination. A: Fundus photography findings. Fundus photography showed a seemingly normal adult ocular fundus without any obvious hard exudate or hemorrhage; B: Optical coherence tomography findings. Optical coherence tomography demonstrated a hypo-reflective space beneath both the neurosensory retina and the pigment epithelium layer; C: Late phase of fluorescein angiography. The late phase of fluorescein angiography revealed increased leakage.

Figure 2

Examination 1 mo later. A: Fundus photography findings. Fundus photography showed a sub-retinal hemorrhage, hard exudate and reddish-orange nodules; B: Optical coherence tomography findings. Optical coherence tomography demonstrated a pigment epithelium detachment and sub-retinal fluid; C: Late phase of fluorescein angiography. The late phase of fluorescein angiography revealed more leakage than that seen one year previously.

Figure 3

Examination 6 mo later. A: Fundus photography findings. Fundus photography showed that there was an obvious sub-retinal hemorrhage at the posterior pole; B: Optical coherence tomography findings. Optical coherence tomography demonstrated a pigment epithelium detachment; C: Fundus photography findings. Fundus photography showed no recurrence of hemorrhage.